Wearable technologies promise to redefine assessment of health behaviors, yet their clinical implementation remains a challenge. To address this gap, two of the NIH's Big Data to Knowledge Centers of ...Excellence organized a workshop on potential clinical applications of wearables. A workgroup comprised of 14 stakeholders from diverse backgrounds (hospital administration, clinical medicine, academia, insurance, and the commercial device industry) discussed two successful digital health interventions that involve wearables to identify common features responsible for their success. Seven features were identified including: a clearly defined problem, integration into a system of healthcare delivery, technology support, personalized experience, focus on end-user experience, alignment with reimbursement models, and inclusion of clinician champions. Health providers and systems keen to establish new models of care inclusive of wearables may consider these features during program design. A better understanding of these features is necessary to guide future clinical applications of wearable technology.
Treatment options for patients suffering from progressive forms of multiple sclerosis (MS) remain inadequate. Mast cells actively participate in the pathogenesis of MS, in part because they release ...large amounts of various mediators that sustain the inflammatory network. Masitinib, a selective oral tyrosine kinase inhibitor, effectively inhibits the survival, migration and activity of mast cells. This exploratory study assessed the safety and clinical benefit of masitinib in the treatment of primary progressive MS (PPMS) or relapse-free secondary progressive MS (rfSPMS).
Multicenter, randomized, placebo-controlled, proof-of-concept trial. Masitinib was administered orally at 3 to 6 mg/kg/day for at least 12 months, with dose adjustment permitted in event of insufficient response with no toxicity. The primary response endpoint was the change relative to baseline in the multiple sclerosis functional composite score (MSFC). Clinical response was defined as an increase in MSFC score relative to baseline of > 100%.
Thirty-five patients were randomized to receive masitinib (N = 27) or placebo (N = 8). Masitinib was relatively well tolerated with the most common adverse events being asthenia, rash, nausea, edema, and diarrhea. The overall frequency of adverse events was similar to the placebo group, however, a higher incidence of severe and serious events was associated with masitinib treatment. Masitinib appeared to have a positive effect on MS-related impairment for PPMS and rfSPMS patients, as evidenced by an improvement in MSFC scores relative to baseline, compared with a worsening MSFC score in patients receiving placebo; +103% ± 189 versus -60% ± 190 at month-12, respectively. This positive, albeit non-statistically significant response was observed as early as month-3 and sustained through to month-18, with similar trends seen in the PPMS and rfSPMS subpopulations. A total of 7/22 (32%) assessable masitinib patients reported clinical response following 12 months of treatment (according to the modified intent-to-treat population, observed cases) compared with none in the placebo group. The Expanded Disability Status Scale remained stable for both treatment groups.
These data suggest that masitinib is of therapeutic benefit to PPMS and rfSPMS patients and could therefore represent an innovative avenue of treatment for this disease. This exploratory trial provides evidence that may support a larger placebo-controlled investigation.
Does the executive's institutional hegemony represent a risk to the survival of democracy? By hegemony, we refer to the president's ability to control other institutions, particularly the legislature ...and judiciary. To answer this question, we develop two indices of presidential hegemony and analyze the duration of democratic regimes in 18 Latin American countries between 1925 and 2016. The results show that executive hegemony is a major driver of democratic instability. This finding is robust to non-linear effects and to potential endogeneity in the relationship between presidential power and democratic backsliding. Our findings challenge traditional concerns about executive-legislative deadlock, and have significant implications for the nascent literature on democratic backsliding, which highlights executive aggrandizement as a risk factor.
We examined the cross-sectional and longitudinal associations of objectively-measured physical activity (step counts) and blood pressure (BP) among adults spanning 37 countries.
Across 37 countries, ...we used data from a pool of 9238 adult owners of Withings' Pulse activity trackers, which measures steps taken each day, and Wireless Blood Pressure Monitor, which measures BP. Analyses were adjusted on age, sex, number of days where the tracker was worn, and number of BP measurements. Data was collected from 2009 to 2013.
Subjects had a mean ± standard deviation (SD) age of 51.6 ± 11.3 years and a body mass index (BMI) of 28.7±5.5 kg/m
. A 1-month increase of more than 3000 steps per day was associated with a decrease of systolic BP (SBP) and diastolic BP (DBP) among the obese (1.57mm Hg and 1.29 mm Hg respectively, both P<0.001) and the overweight population (0.79 mm Hg and 0.84 mm Hg respectively, both P≤0.001), but not in the normal weight population (P=0.60 and P=0.36 respectively).
One-month increases in daily step counts was associated with a decrease of SBP and DBP in a large obese and overweight free living population.
En este artículo se establecen los factores que influyen en los distintos niveles de involucramiento de la ciudadanía en las elecciones municipales en Uruguay a partir de 2010. Diversos estudios ...muestran que la concurrencia a votar en las elecciones locales es inferior a las nacionales, pero que la participación aumenta a medida que disminuye el tamaño del municipio. Sin embargo, en Uruguay la concurrencia a votar es muy alta en todas las elecciones porque el voto es obligatorio. Por esa razón, utilizamos una forma original para medir el involucramiento de la ciudadanía en las elecciones subnacionales mediante la cuantificación del “voto en blanco parcial” o la abstención de nivel, que captura el porcentaje de quienes asisten a votar, pero se abstienen en alguno de los niveles (departamental o municipal). Verificamos que la relación inversa entre tamaño del municipio y participación electoral también se cumple aun cuando el voto obligatorio no la muestra en la concurrencia a votar, pues en muchas municipalidades pequeñas los votos por las autoridades locales superan los obtenidos por las departamentales, con lo cual se invierte la relación del modelo de elecciones de segundo nivel. Nuestros hallazgos permiten observar diferentes niveles de involucramiento de la ciudadanía, más allá de la mera concurrencia a votar, la única variable analizada hasta ahora por la comunidad académica.
In this contribution, the oil speed in horizontal channels of an oil-directed cooled winding is investigated by experimental and numerical methods. The presented winding model offers insight into the ...horizontal cooling channels perpendicular to the main oil-flow direction. To visualize oil flow, tracing particles were added to the cooling oil and illuminated by high-power light-emitting diodes. The particle velocities were then determined by taking photographs with a defined exposure time. The design of the sophisticated winding model is described in the contribution. In addition to the experimental results, this contribution presents a comparison with respective numerical results from 2-D and 3-D computational fluid dynamics calculations. Finally, numerical results from the winding model concerning the oil-flow distribution inside the winding at various operating conditions are presented. The investigation indicated a strong nonuniform oil-flow distribution on the horizontal channels. The presented results give a deep insight into the oil flow and temperature behavior of windings, enabling the designer to optimize the cooling of the power transformer windings.
Orthophosphate was mobilized from iron phosphate (FePO
4) contained in digested sewage sludge by microbial fuel cell power. FePO
4 was reduced through electrons and protons obtained from metabolic ...activity of
Escherichia coli. The process yielded up to 82% or 600
mg/l. Optical emission spectroscopy was used for phosphate dosage.
31P NMR showed a singlet at
δ
p
=
3.72
ppm indicating that orthophosphate (
H
3
PO
4
,
HPO
4
-
,
HPO
4
2
-
and
PO
4
3
-
) was recovered. The phosphate containing supernatant solution was reacted with stoichiometric amounts of MgCl
2 and NH
4OH to precipitate struvite (MgNH
4PO
4·6H
2O). The crystalline fertilizer was analyzed by scanning electron microscopy comprising elemental analysis, revealing a composition accuracy of ∼90% and the absence of any toxic metals such as As, Cd, Pb, or Cr. The phosphate extraction is also a means to reduce the volume of digested sewage sludge while increasing the heat of combustion. This study represents a concept for sustainable decentralized phosphate recycling.
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